Condoms 'too big' for Indian men By Damian Grammaticus BBC News, Delhi

There is a "lack of awareness" over condom sizes A survey of more than 1,000 men in India has concluded that condoms made according to international sizes are too large for a majority of Indian men.

The study found that more than half of the men measured had penises that were shorter than international standards for condoms.

It has led to a call for condoms of mixed sizes to be made more widely available in India.

The two-year study was carried out by the Indian Council of Medical Research.

Over 1,200 volunteers from the length and breadth of the country had their penises measured precisely, down to the last millimetre.

The scientists even checked their sample was representative of India as a whole in terms of class, religion and urban and rural dwellers.

It's not size, it's what you do with it that matters

Sunil Mehra The conclusion of all this scientific endeavour is that about 60% of Indian men have penises which are between three and five centimetres shorter than international standards used in condom manufacture.

Doctor Chander Puri, a specialist in reproductive health at the Indian Council of Medical Research, told the BBC there was an obvious need in India for custom-made condoms, as most of those currently on sale are too large.

The issue is serious because about one in every five times a condom is used in India it either falls off or tears, an extremely high failure rate.

And the country already has the highest number of HIV infections of any nation.

'Not a problem'

Mr Puri said that since Indians would be embarrassed about going to a chemist to ask for smaller condoms there should be vending machines dispensing different sizes all around the country.

"Smaller condoms are on sale in India. But there is a lack of awareness that different sizes are available. There is anxiety talking about the issue. And normally one feels shy to go to a chemist's shop and ask for a smaller size condom."

But Indian men need not be concerned about measuring up internationally according to Sunil Mehra, the former editor of the Indian version of the men's magazine Maxim.

"It's not size, it's what you do with it that matters," he said.

"From our population, the evidence is Indians are doing pretty well.

"With apologies to the poet Alexander Pope, you could say, for inches and centimetres, let fools contend."

South African men might enjoy buying extra large condoms A range of extra-large condoms has been launched in South Africa, to cater for "well-endowed" men. "A large number of South African men are bigger and complain about condoms being uncomfortable and too small," said Durex manager Stuart Roberts.

Aids activists say the new condom could encourage men to practise safe sex in South Africa, where some 6m are HIV positive - more than any other country.

Some South Africans are reluctant to use condoms, says activist Thandi Xolo.

Mr Xolo, from the National Association of People Living With HIV/Aids (Napwa), said both men and women fear being labelled as promiscuous if they are seen with condoms.

"This could help condoms become cool," he said. "Men will buy them to boost their ego."

Even more importantly, it will remove the excuse made by some men for not using condoms - that they are too small.

However, Mr Xolo said he was not sure how many of the millions of condoms sold each year in South Africa were being properly used.

"The practice of embellishing the human body by injecting oils beneath the skin has been known for over a century," according to urologist, Institute of Urology and Nephrology (IUN) in London, Mr Manit Arya.

"Increasing the size of the girth of the penis is common in South East Asia as well as in Japan."

"For instance, in Japan, the Yakuza often plant spherical objects under the skin of the penis to increase its size," said Mr Manit.

Travel

Doctors believe that men in Britain may be becoming interested in the practice after travelling to Asia on holiday.

In all of these cases of penis enlargement by injection of oils, dangerous side effects develop

Mr Manit Arya However, Mr Manit and his colleagues at the IUN were extremely surprised when a 31-year old British born man presented at their clinic for treatment recently for gross abnormality of the penis and ulceration as a result of injecting oils under his skin.

"This was the first case we had seen. It was a very interesting case.

"The man had used a high-pressure pneumatic grease gun to inject his penis.

"But the girth of the man's penis continued to grow and he was no longer able to achieve an erection.

"He needed urgent treatment for both problems."

The man was treated by careful removal of dead tissue under the skin of the penis by surgery.

Counselling

He was also offered psychological counselling.

He apparently injected himself with oil to give himself more confidence sexually.

Although plastic surgeons currently conduct gender operations where a man or woman has their genitals altered, no plastic surgeon will conduct a penis girth enlargement operation.

"Unlike breast implants where some women experience severe side effects, in all of these cases of penis enlargement by injection of oils, dangerous side effects develop," Mr Manit said.

"The skin of the penis either dies or else becomes severely ulcerated in all cases."

Gender operations are currently performed in the UK when a doctor believes a person's psychological health depends on a sex change operation.

Mr Manit was one of the researchers of a IUN team who recently published a paper on grease gun injury in the Journal of The Royal Society of Medicine.